Research Papers

Evaluation of Feedback Enabled Active Colonoscopy Training Model

[+] Author and Article Information
Ravindra Kale

Research Assistant
Mechanical Engineering Department,
Ohio University,
Athens, OH 45701

David Koonce

Associate Professor
Industrial Systems Engineering Department,
Ohio University,
Athens, OH 45701

David Drozek

Assistant Professor of Surgery,
Department of Specialty Medicine,
Ohio University Heritage College of
Osteopathic Medicine,
Athens, OH 45701

JungHun Choi

Assistant Professor
Mechanical Engineering and
Biomedical Engineering Program,
Ohio University,
Athens, OH 45701

Manuscript received September 24, 2012; final manuscript received June 11, 2013; published online September 24, 2013. Assoc. Editor: Carl A. Nelson.

J. Med. Devices 7(4), 041008 (Sep 24, 2013) (7 pages) Paper No: MED-12-1116; doi: 10.1115/1.4024831 History: Received September 24, 2012; Revised June 11, 2013

The objective of this research is to evaluate the efficacy of an active colonoscopy training model (ACTM). Colonoscopy is a widely utilized procedure for diagnosing diseases of the lower gastrointestinal tract. Since colonoscopy is a difficult procedure to teach, as well as learn, simulators are often used to teach and practice the procedure. To make learning and assessing the procedural skills easy and interactive, an active training model was developed and evaluated. To measure the applied force and the time to complete the procedure, load cells and light detecting sensors were installed in the training model and were interfaced with a data acquisition system. The user interface was programmed in LabVIEW to record the force data and time taken to complete the procedure. Thirty medical students were recruited to perform a series of three colonoscopies on the ACTM. These students were instructed how to handle the equipment and perform the colonoscopy. The procedure was also performed by experienced endoscopists to establish a benchmark. The collected data were analyzed to determine the effectiveness of the device to (1) distinguish between the participants based on their level of expertise, and (2) to detect improvement in skill of the students with repetitive sessions with the device. The results of this research may be useful to show that the ACTM may be an effective tool to integrate in to the medical training program of medical studies. It can be possibly used for evaluating the skill sets, as well as practicing the procedure before a novice surgeon performs the procedure on a patient.

Copyright © 2013 by ASME
Topics: Students , Feedback
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Hogan, W. J., 1993, “What Constitutes Endoscopic Competence?” Gastroenterology, 104(5), pp. 1564–1565. [PubMed]
Baillie, J., and Ravich, W. J., 1993, “On Endoscopic Training and Procedural Competence,” Ann. Internal Med., 118(1), p. 73. [CrossRef]
Church, J., Oakley, J., and Milsom, J., 2002, “Colonoscopy Training: The Need for Patience (Patients),” ANZ J. Surgery, 72(2), pp. 89–91. [CrossRef]
Teague, R. H., 2000, “Can We Teach Colonoscopic Skills?,” Gastrointestinal Endosc., 51(1), pp. 112–114. [CrossRef]
Okuda, Y., Bryson, E. O., and DeMaria, S., Jr., 2009, “The Utility of Simulation in Medical Education: What is the Evidence?,” Mount Sinai J. Medicine: A J. Transl. and Personalized Med., 76(4), pp. 330–343. [CrossRef]
Bar-Meir, S., 2000, “A New Endoscopic Simulator,” Endoscopy, 32(11), pp. 898–900. [CrossRef] [PubMed]
Adamsen, S., 2000, “Simulators and Gastrointestinal Endoscopy Training,” Endoscopy, 32(11), pp. 895–897. [CrossRef] [PubMed]
Rex, D. K., 2000, “Colonoscopic Withdrawal Technique is Associated With Adenoma Miss Rates,” Gastrointestinal Endosc., 51(1), pp. 33–36. [CrossRef]
Peyton, R., 1996, “College Has Found Strong Demand for Training Programmes,” Br. Med. J., 312(7041), pp. 1301. [CrossRef]
Wipf, J. E., Orlander, J. D., and Anderson, J. J., 1999, “The Effect of a Teaching Skills Course on Interns' and Students' Evaluations of Their Resident-Teachers,” Academic Medicine, 74(8), p. 938. [CrossRef] [PubMed]
Jones, I. T., 1998, “Training in Colonoscopy: A Personal View,” Australian and New Zealand J. Surg., 68(5) pp. 316–317. [CrossRef]
Sedlack, R. E., Baron, T. H., Downing, S. M., 2007, “Validation of a Colonoscopy Simulation Model for Skills Assessment,” Am. J. Gastroenterology, 102(1), pp. 64–74. [CrossRef]
Chak, A., Cooper, G. S., and Blades, E. W., 1996, “Prospective Assessment of Colonoscopic Intubation Skills in Trainees,” Gastrointestinal Endoscopy, 44(1), pp. 54–57. [CrossRef] [PubMed]
Rex, D. K., Petrini, J. L., and Baron, T. H., 2006, “Quality Indicators for Colonoscopy,” Gastrointestinal Endoscopy, 63(4), pp. 16. [CrossRef] [PubMed]
Appleyard, M. N., Mosse, C. A., and Mills, T. N., 2000, “The Measurement of Forces Exerted During Colonoscopy,” Gastrointestinal Endoscopy, 52(2) pp. 237–240. [CrossRef] [PubMed]
Cataldo, P. A., 1996, “Colonoscopy Without Sedation,” Diseases of the Colon & Rectum, 39(3) pp. 257–261. [CrossRef]
Saunders, B. P., Fukumoto, M., Halligan, S., 1994, “Patient-Administered Nitrous Oxide/Oxygen Inhalation Provides Effective Sedation and Analgesia for Colonoscopy,” Gastrointestinal Endoscopy, 40(4), pp. 418–421. [CrossRef]
Samur, E., Flection, L., and Spaelter, U., 2008, “A Haptic Interface With Motor/Brake System for Colonoscopy Simulation,” Symposium on Haptic Interfaces for Virtual Environment and Teleoperator Systems (Haptis 2008), Reno, NV, March 13–14, pp. 477–478. [CrossRef]
Samur, E., Flaction, L., and Bleuler, H., 2011, “Experimental Evaluation of a Haptic Interface for Endoscopic Simulation,” IEEE World Haptics Conference (WHC), Istanbul, June 21–24, pp. 545–549. [CrossRef]
Yi, S., Woo, H., and Ahn, W., 2006, “New Colonoscopy Simulator With Improved Haptic Fidelity,” Adv. Robotics, 20(3) pp. 349–365. [CrossRef]
Ahn, W., Kim, W., and Woo, H., 2007, “Colonoscopy Simulator With Enhanced Haptic Realism and Visual Feedback,” World Congress on Medical Physics and Biomedical Engineering 2006, Springer, Berlin, pp. 3820–3823. [CrossRef]
Woo, H. S., Kim, W. S., and Ahn, W., 2008, “Haptic Interface of the KAIST-Ewha Colonoscopy Simulator II,” IEEE Trans. Information Technology in Biomedicine, 12(6) pp. 746–753. [CrossRef]
Aabakken, L., Adamsen, S., and Kruse, A., 2000, “Performance of a Colonoscopy Simulator: Experience From a Hands-on Endoscopy Course,” Endoscopy, 32(11), pp. 911–913. [CrossRef]
Sedlack, R. E., and Kolars, J. C., 2003, “Validation of a Computer-Based Colonoscopy Simulator,” Gastrointestinal Endoscopy, 57(2), pp. 214–218. [CrossRef]
Fernandez-Sordo, J. O., Madrigal-Hoyos, E., and Waxman, I., 2011, “The Role of Live Animal Models for Teaching Endoscopy,” Techniques in Gastrointestinal Endoscopy, 13(2), pp. 113–118. [CrossRef]
Sedlack, R., Petersen, B., and Binmoeller, K., 2003, “A Direct Comparison of ERCP Teaching Models,” Gastrointestinal Endoscopy, 57(7), pp. 886–890. [CrossRef]
Choi, J. H., and Kale, R., 2011, “Localization of the Distal Tip in the Colonoscopy Training Model Using Light Sensors,” ASME J. Med. Devices, 5(2), p. 027535. [CrossRef]
Choi, J., Ravindra, K., and Robert, R., 2011, “Preliminary Development of the Active Colonoscopy Training Model,” Medical Devices: Evidence and Research, 4, pp. 59–70. [CrossRef]
Bell, G., Hancock, J., and Painter, J., 2000, “Pain During Flexible Sigmoidoscopy and Colonoscopy: When and Why Does It Occur,” Gut, 46(S2), p. A30. [CrossRef]
Dogramadzi, S., Virk, G., and Bell, G., 2005, “Recording Forces Exerted on the Bowel Wall During Colonoscopy: In Vitro Evaluation,” Int. J. Medical Robotics and Computer Assisted Surgery, 1(4), pp. 89–97. [CrossRef]


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Fig. 1

The active colonoscopy training model. In the colonoscopy platform, 10 force sensors and 24 light detecting sensors were installed. The force sensors are embedded in the body of mannequin (colonoscopy platform) and are triggered when the black rings are placed on tension. The light detecting sensors (photocells) are attached on the silicone colon for the localization of the distal tip.

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Fig. 2

Load cells installed in the colonoscopy platform [28]. The load cells were installed and embedded in the platform and interfaced with the load cell drivers connected to the data acquisition system.

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Fig. 3

LabVIEW Front Panel developed for the ACTM. User interface programmed in LabVIEW to collect and record the data. This front panel displayed the real time force values, real time warnings, and the duration of time required by the participant in a specific part of the colon.

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Fig. 4

Average forces in the parts of the colon. The figure shows the average forces recorded in the parts of the colon in three trials of the colonoscopy performed on the ACTM.

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Fig. 5

Percentage decrease in time required to advance the colonoscope through the parts of the colon during the three trials. The average time required in each part of the colon in trial 1 is considered as base and the time required in trial 2 and trial 3 is plotted as shown.



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